Maryland's Global Budget Revenue Program: Impact on Neonatal Intensive Care Unit Admissions and Infant Mortality.

BACKGROUND: In 2014, Maryland implemented the Global Budget Revenue (GBR) program to reduce unnecessary hospital utilization and contain spending. Little is known about its impact on pediatric health outcomes and high-cost services that are primarily financed by payers other than Medicare. OBJECTIVE: The aim was to examine the impact of the GBR program on neonatal intensive care unit (NICU) admission and infant mortality. RESEARCH DESIGN: We conducted a difference-in-differences analysis comparing changes of NICU admissions and infant mortality in Maryland with changes in 20 comparison states (including DC), before and after implementation of the GBR program. Effects were estimated for all infants and for risk groups defined by birthweight and gestation. SUBJECTS: A total of 11,965,997 newborns in Maryland and the comparison states was identified using US birth certificate data from 2011 to 2017. MEASURES: NICU admissions, the infant mortality rate, and the neonatal mortality rate. RESULTS: The GBR program was associated with a 1.26 percentage points (-16.8%, P=0.03) decline in NICU admissions over three full years of implementation. Reductions were driven by fewer admissions among moderately low to normal birthweight (1500-3999 g) and moderately preterm to term (32-41 wk) infants. The effects for very-low birthweight and very preterm infants were small and not statistically precise. There was no significant change in infant or neonatal mortality rates. CONCLUSIONS: Maryland's hospitals reacted to the GBR program by reducing NICU services for infants that did not have clear observed clinical need. Our results suggest that GBR constrained high-cost services, without adversely affecting infant mortality.

Year in review 2007: Critical Care--intensive care unit management.

With the development of new technologies and drugs, health care is becoming increasingly complex and expensive. Governments and health care providers around the world devote a large proportion of their budgets to maintaining quality of care. During 2007, Critical Care published several papers that highlight important aspects of critical care management, which can be subdivided into structure, processes and outcomes, including costs. Great emphasis was given to quality of life after intensive care unit stay, especially the impact of post-traumatic stress disorder. Significant attention was also given to staffing level, optimization of intensive care unit capacity, and drug cost-effectiveness, particularly that of recombinant human activated protein C. Managing costs and providing high-quality care simultaneously are emerging challenges that we must understand and meet.

Um estudo de caso sobre a metodologia de custeio adotada pela Unidade de Nutrição e Dietética de um hospital / Cost-management methodology of a hospital nutrition and diet unit: a case study

Este artigo apresenta um estudo de caso realizado numa instituição hospitalar, com a finalidade de analisar o método de custeio adotado pela Unidade de Nutrição e Dietética. A Unidadade de Nutrição e Dietética adota o método de custeio ponderado, onde são atribuídos pesos às diferentes refeições dependendo da importância (ou onerosidade) delas. Comparativamente, aplicou-se o método de custeio por absorção. Analisando-se os resultados, percebeu-se uma grande distorção entre os dois métodos. Concluiu-se que as distorções ocorreram em função dos graus de subjetividade quanto à atribuição de pesos, no método de custeio por absorção. Diante dos resultados obtidos, foi sugerido que a instituição adote um método de custeio que mensure com maior exatidão o custo, como, por exemplo, metodologia de custeio baseado em atividades - ABC (Activity Based Costing).

Administraçäo orçamentária em hospitais públicos: estudo de caso / Budgetary management in public hospitals: case study

Estudo de caso, no qual o objeto é a implantaçäo de um sistema de gestäo orçamentária em instituiçöes públicas de saúde. O Estudo se passa no Projeto REFORSUS, em especial o Projeto Piloto de Modernizaçäo Gerencial em Grandes Estabelecimentos de Saúde. Investiga e identifica os principais aspectos da introduçäo da administraçäo orçamentária nos hospitais públicos, no período de julho de 2001 a dezembro de 2002. Identifica as contribuiçöes da mesma para a melhoria da administraçäo econômico-financeira hospitalar e da administraçäo dos recursos destinados à área de saúde de cada Estado. Aborda o orçamento público, seu conceito, histórico, evoluçäo e procedimentos. Ilustra a aplicaçäo do orçamento público às organizaçöes de saúde. Explica o sistema de saúde brasileiro.

"Voluntary" user fees in Buenos Aires hospitals: innovation or imposition?

Voluntary user fees in hospitals in Buenos Aires, which operate outside official controls, have not featured in other studies of health care in Argentina. After providing a historical overview of different hospital funding sources, the authors focus on the activity of cooperadoras--the organizations responsible for levying voluntary fees. Using detailed data from two case-study hospitals and more general financial sources, they assess the importance of these fees, identifying sharp variations between different hospitals, serious problems of under-reporting, and potential abuses. The authors also examine the means by which fees are levied and the degree of coercion involved. Voluntary fees are not a particularly successful funding strategy: the income they generate is variable; they are almost entirely unregulated; and they sometimes conflict with other, more legitimate funding sources. Most importantly, their voluntaristic aspect is largely notional: most patients are heavily pressured to make payments. The main motivation for continuing with voluntary fees is to avoid the political fallout that would probably result from introduction of a formal user fees policy.

Sistema de información hospitalaria integrada: una propuesta / Integral informaton system for hospital: a proposal

La existencia de sistemas de informacion integrales para los hospitales es una preocupacion constante para quienes deben tomar deciciones en forma oportuna. Este trabajo traduce la necesidad de desarrollar un sistema de informacion que cubra todos los elementos y actividades de un hospital como herramienta básica para una mejora continua de la calidad de la atención médica y como medio de contencion de costos.(au)

Implementing the Medicare electronic remittance advice.

Some hospitals have delayed converting to the electronic remittance advice recently implemented by the Health Care Financing Administration because the process is unfamiliar and because the electronic data interchange (EDI) translation software is expensive. However, the University of Pittsburgh Medical Center (UPMC) found that it could begin to reap the benefits of EDI technology by using existing software and hardware along with a common-sense approach to implementation. As a result, UPMC has begun an organizationwide EDI initiative designed to reduce costs and improve cash flow.

It's a jungle out there: strategies for controlling information systems costs.

This article discusses four major areas where healthcare financial managers can reconcile the conflicting goals their healthcare organizations face: keeping up with the latest in technology while at the same time constantly striving to reduce healthcare information systems costs.

Cost accounting supports clinical evaluations.

This article describes how a hospital cost accounting system was used to evaluate the financial impact of the use of a new and expensive drug at a 700-bed academic medical center.

Adapting to the ANSI 835 transaction set.

Adapting to the American National Standards Institute (ANSI) 835 Health Care Claims Payment/Advice format--the first nationwide, all-payer electronic standard for healthcare claims--requires an approach tailored to the individual provider's system. Providers have four options for receiving ANSI 835 claims payments. They include: direct transmission from payers, value added network services (VANs), banks with electronic data interchange capabilities, and paper reports. Providers' claims processing systems vary enormously in the formats they use and in their capacities to transmit and receive claims payments electronically. Author Romo reviews factors that providers need to consider when refining internal capabilities and selecting external processors to accept the 835 format.

Manual de custos hospitalares: uma metodologia simplificada / Manual of hospitalar costs: a simplified methodology

O manual fornece orientaçöes técnicas destinadas ao aprimoramento da gestäo dos hospitais brasileiros. Contribui para a ampliaçäo de informaçöes de custos da rede hospitalar, de forma a subsidiar as próprias entidades representativas, na defesa dos níveis de remuneraçäo dos serviços hospitalares (AMSB)

Cost cutting for hospitals: a heuristic approach.

This article has suggested a model that can provide some consistency and order as hospital managers attempt to find reliable yet palatable means of cutting their institutions' costs. Like any model, it is only as sensitive as the manner in which it is applied; it is a guide rather than a substitute for clear thinking by management. Used in context, however, the model encourages clear thinking when hospital managers might otherwise be tempted to dispose of facts that do not conform to their own theories or, alternatively, find isolated budget solutions that are simple and neat but suboptimal. In the final analysis, thinking clearly is the ultimate model when the order comes to cut costs.

Equipamiento hospitalario: la adquisición de insumos y tecnología / Health devices: devices and dollars

Clausulas contractuales. Incumplimiento del vendedor. Alternativas de financiación: compras al contado, leasings, alquileres. Tasa de interes. Análisis de valor para maximizar la efectividad, eficiencia y eficacia del equipo analizado

Equipamiento hospitalario: la adquisición de insumos y tecnología / Health devices: devices and dollars

Clausulas contractuales. Incumplimiento del vendedor. Alternativas de financiación: compras al contado, leasings, alquileres. Tasa de interes. Análisis de valor para maximizar la efectividad, eficiencia y eficacia del equipo analizado

Referral tracking system shows accurate bottom-line assessment.

Rose Medical Center in Denver, Colo., needed a way to track referrals from its many offsite care centers to determine their impact on revenue. Programmers at Rose developed a microbased system, eventually bought by SMS, that measures profitability against investment to become a true decision support tool for hospital executives.